Roscoe, Jeremy Wade

Roscoe, Jeremy Wade is an sole proprietor health care provider with primary practice located at 401 Camby Ct , Greenwood IN 46142-4085. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as his primary health care specialty. Roscoe, Jeremy Wade can be contacted via phone (317) 881-8737.

Contact Information

Primary practice address
401 Camby Ct Greenwood IN 46142-4085
Phone: (317) 881-8737
Fax: (317) 881-8735
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 1057187 Indiana

Profile Details

NPI number 1386620961
LBN Legal business name Roscoe, Jeremy Wade
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Dec 15th, 2005
Last updated May 9th, 2011 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1386620961 NPPES
Indiana Other 371487209 TAX ID
Indiana MEDICAID 200479420A TAX ID

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